Mohammad Azmi N, Dualim DM, Chandrakanthan SB, Mohd Azman ZA, Mohd Hayati MF, Zakaria AD. Letter to the Editor: Rethinking emergency care pathways for acute intestinal obstruction: From haywire to high performance. World J Gastrointest Surg 2026; 18(6): 118291 [DOI: 10.4240/wjgs.118291]
Corresponding Author of This Article
Andee Dzulkarnaen Zakaria, MD, Professor, Department of Surgery, School of Medical Sciences & Hospital USM, Universiti Sains Malaysia, 11800 Gelugor, Pulau Pinang, Kota Bharu 16150, Kelantan, Malaysia. andee@usm.my
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Surgery
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letter
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Mohammad Azmi N, Dualim DM, Chandrakanthan SB, Mohd Azman ZA, Mohd Hayati MF, Zakaria AD. Letter to the Editor: Rethinking emergency care pathways for acute intestinal obstruction: From haywire to high performance. World J Gastrointest Surg 2026; 18(6): 118291 [DOI: 10.4240/wjgs.118291]
World J Gastrointest Surg. Jun 27, 2026; 18(6): 118291 Published online Jun 27, 2026. doi: 10.4240/wjgs.118291
Letter to the Editor: Rethinking emergency care pathways for acute intestinal obstruction: From haywire to high performance
Nabil Mohammad Azmi, Diana Melissa Dualim, Soma Balaganapati Chandrakanthan, Zairul Azwan Mohd Azman, Mohd Firdaus Mohd Hayati, Andee Dzulkarnaen Zakaria
Nabil Mohammad Azmi, Diana Melissa Dualim, Soma Balaganapati Chandrakanthan, Zairul Azwan Mohd Azman, Department of Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
Mohd Firdaus Mohd Hayati, Department of Surgery, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
Andee Dzulkarnaen Zakaria, Department of Surgery, School of Medical Sciences & Hospital USM, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia
Co-corresponding authors: Mohd Firdaus Mohd Hayati and Andee Dzulkarnaen Zakaria.
Author contributions: Mohammad Azmi N contributed to the writing and editing of the manuscript and review of the literature; Dualim DM, Chandrakanthan SB, and Mohd Azman ZA contributed equally for the manuscript; Mohd Hayati MF and Zakaria AD contributed to the discussion and design of the manuscript and contributed equally as co-corresponding authors; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Andee Dzulkarnaen Zakaria, MD, Professor, Department of Surgery, School of Medical Sciences & Hospital USM, Universiti Sains Malaysia, 11800 Gelugor, Pulau Pinang, Kota Bharu 16150, Kelantan, Malaysia. andee@usm.my
Received: December 29, 2025 Revised: January 14, 2026 Accepted: February 9, 2026 Published online: June 27, 2026 Processing time: 167 Days and 22.9 Hours
Abstract
Acute intestinal obstruction remains one of the most unforgiving surgical emergencies, where delays measured in minutes – not hours – can determine bowel viability, complication rates, and survival. While advances in imaging and operative techniques have improved surgical outcomes, the organizational processes that govern early emergency care often receive far less scrutiny. In this context, Wang et al, published a study in the recent issue of the World Journal of Gastrointestinal Surgery, provide a timely and thought-provoking contribution by demonstrating how a structured multidisciplinary team (MDT)-based emergency nursing pathway can translate system design into measurable clinical benefits. The study also challenges traditional doctor-centric models by highlighting nursing-led team collaboration as a central integrator. It offers an insightful view of how a structured MDT-based emergency care pathway can significantly improve efficiency through clear, predefined roles, interdepartmental communication timelines, and escalation mechanisms. As emergency departments worldwide grapple with overcrowding and workforce strain, structured MDT nursing pathways may offer scalable solutions.
Core Tip: The time to coordination before surgery matters as much as the time to surgery itself. Early, structured multidisciplinary team (MDT) activation in acute intestinal obstruction can significantly shorten triage and treatment times, thereby reducing the risk of bowel ischemia and improving postoperative outcomes. Nursing-led team collaboration plays a central role in coordination, ensuring timely information transfer, prompt responses from key departments, and appropriate escalation of care. This thought-provoking study shows that MDT-based models are effective in promoting early collaboration, timely responses, and structured decision-making. Despite ongoing challenges, their potential to optimize outcomes in acute intestinal obstruction should not be underestimated. This editorial presents a compelling case that an MDT-based care pathway may improve efficiency, reduce emergency department backlogs, and enhance surgical outcomes even in resource-limited settings.
